HSE Return to Work Questionnaire

• Client / Site

• Department

• Location
  Address

• Conducted on

  Date

• Prepared by

Demands

• Did different people at work demand things from you that were hard to combine?

  Yes

  No

  N/A

• Did you have unachievable deadlines?

  Yes

  No

  N/A

• Did you have to work very intensively?

  Yes

  No

  N/A

• Did you have to neglect some tasks because you had too much to do?

  Yes

  No

  N/A

• Were you unable to take sufficient breaks?

  Yes

  No

  N/A

• Did you feel pressured to work long hours?

  Yes

  No

  N/A

• Did you feel you had to work very fast?

  Yes

  No

  N/A

• Did you have unrealistic time pressures?

  Yes

  No

  N/A

Control

• Could you decide when to take a break?

  Yes

  No

  N/A

• Did you feel you had a say in your work speed?

  Yes

  No

  N/A

• Did you feel you had a choice in deciding how you did your work?

  Yes

  No

  N/A

• Did you feel you had a choice in deciding what you did at work?

  Yes

  No

  N/A

• Did you feel you had some say over the way you did your work?

  Yes

  No

  N/A

• Did you feel your time could be flexible?

  Yes

  No

  N/A

Support

• Did your manager give you enough supportive feedback on the work you did?

  Yes

  No

  N/A

• Did you feel you could rely on your manager to help you with a work problem?

  Yes

  No

  N/A

• Did you feel you could talk to your manager about something that upset or annoyed you at work?

  Yes

  No

  N/A

• Did you feel your manager supported you through any emotionally demanding work?

  Yes

  No

  N/A

• Did you feel your manager encouraged you enough at work?

  Yes

  No

  N/A

Peers

• Did you feel your colleagues would help you if work became difficult?

  Yes

  No

  N/A

• Did you get the help and support you needed from your colleagues?

  Yes

  No

  N/A

• Did you get the respect at work you deserved from your colleagues?

  Yes

  No

  N/A

• Were your colleagues willing to listen to your work-related problems?

  Yes

  No

  N/A

Relationships

• Were you personally harassed, in the form of unkind words or behavior?

  Yes

  No

  N/A

• Did you feel there was friction or anger between colleagues?

  Yes

  No

  N/A

• Were you bullied at work?

  Yes

  No

  N/A

• Were relationships strained at work?

  Yes

  No

  N/A

Role

• Were you clear about what was expected of you at work?

  Yes

  No

  N/A

• Did you know how to go about getting your job done?

  Yes

  No

  N/A

• Were you clear about what your duties and responsibilities were?

  Yes

  No

  N/A

• Were you clear about the goals and objectives for this department?

  Yes

  No

  N/A

• Did you understand how your work fits into the overall aim of the organization?

  Yes

  No

  N/A

Change

• Did you have enough opportunities to question managers about change at work?

  Yes

  No

  N/A

• Did you feel consulted about change at work?

  Yes

  No

  N/A

• When changes were made at work, were you clear about how they would work out in practice?

  Yes

  No

  N/A

Other issues

• Is there anything else that was a source of stress for you, at work or at home, that may have contributed to you going off work with work-related stress?

  Yes

  No

  N/A

Completion

• Full Name and Signature of Inspector

  Sign